Previous Preterm Cesarean Delivery and Risk of Subsequent Uterine Rupture (original) (raw)
Related papers
Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery
Obstetrics and Gynecology, 2007
OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery has generally compared the risk after trial of labor to that occurring with an elective cesarean delivery without labor. Because antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat cesarean delivery or whether labor will occur before scheduled cesarean delivery, the purpose of this analysis was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women at term with a history of prior cesarean delivery.
Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery
The New England Journal of Medicine, 2001
Background Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication. Methods We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor. Results Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 per 1000 among women with spontaneous onset of labor (56 women), 7.7 per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 per 1000 among women with prostaglandin-induced labor (9 women). As compared with the risk in women with repeated cesarean delivery without labor, uterine rupture was more likely among women with spontaneous onset of labor (relative risk, 3.3; 95 percent confidence interval, 1.8 to 6.0), induction of labor without prostaglandins (relative risk, 4.9; 95 percent confidence interval, 2.4 to 9.7), and induction with prostaglandins (relative risk, 15.6; 95 percent confidence interval, 8.1 to 30.0). Conclusions For women with one prior cesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated cesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk.
American Journal of Obstetrics and Gynecology, 2000
There has been little investigation of the impact of previous vaginal delivery on morbidity during a trial of labor after cesarean delivery. McMahon et al 1 examined morbidity during labor and delivery in women undergoing a trial of labor versus elective repeat cesarean delivery. These authors examined morbidity with a trial of labor for the subgroup of women who had both previous cesarean and previous vaginal deliveries. Although they found no clear increase in major morbidity with increasing parity, they did not directly compare the morbidity in women with a prior vaginal birth and morbidity in women without a previous vaginal delivery. In addition, because most of the major morbidity was a result of operative injury (73%) and not uterine rupture, it is not possible to discern the association of previous vaginal delivery with uterine rupture from this study.
Archives of Gynecology and Obstetrics, 2011
Purpose To determine the risk of uterine rupture for women undergoing trial of labour (TOL) with both a prior caesarean section (CS) and a vaginal delivery. Methods A systematic literature search was performed using keywords for CS and uterine rupture. The results were critically appraised and the data from relevant and valid articles were extracted. Odds ratios were calculated and a pooled estimate was determined using the Mantel-Haenszel method. Results Five studies were used for final analysis. Three studies showed a significant risk reduction for women with both a previous CS and a prior vaginal delivery (PVD) compared to women with a previous CS only, and two studies showed a trend towards risk reduction. The absolute risk of uterine rupture with a prior vaginal delivery varied from 0.17 to 0.46%. The overall odds ratio for PVD was 0.39 (95% CI 0.29-0.52, P \ 0.00001). Conclusion Women with a history of both a CS and vaginal delivery are at decreased risk of uterine rupture when undergoing TOL compared with women who have only had a CS.
Archives of Gynecology and Obstetrics, 2022
Purpose: Previous cesarean delivery (CD) is the main risk factor for uterine rupture when attempting a trial of labor. Previous vaginal delivery (PVD) is a predictor for trial of labor after cesarean (TOLAC) success and a protective factor against uterine rupture. We aimed to assess the magnitude of PVD as a protective factor from uterine rupture. Methods : A retrospective cohort study was conducted, including women who underwent TOLACs from 2003-2015. Women with and without PVD were compared. Inclusion criteria were one previous CD, trial of labor at ≥24 weeks' gestation, and cephalic presentation. We excluded pre-labor intrauterine fetal death and fetal anomalies. The primary outcome was uterine rupture. Secondary outcomes were maternal and fetal complications. Logistic regression modeling was applied to analyze the association between PVD and uterine rupture while controlling for confounders. Results: A total of 11,235 women undergoing TOLAC were included, 6,795 of whom had a PVD. Women with PVD had signi cantly lower rates of uterine rupture (0.18% vs. 1.1%; OR 0.19, p<0.001), were less likely to be delivered by an emergency CD (13.2% vs. 39.4%, OR 0.17, p<0.0001), were more likely to undergo labor induction (OR 1.56, p<0.0001), and were less likely to undergo an instrumental delivery (OR 0.14, p<0.001). Logistic regression modeling revealed that PVD was the only independent protective factor, with an aOR of 0.22. Conclusion: PVD is the most important protective factor from uterine rupture in patients undergoing TOLAC. A trial of labor following one CD should therefore be encouraged in these patients. Introduction: Cesarean delivery (CD) rates have increased signi cantly worldwide over the past decades. Latest available data show that 21% of women worldwide gave birth by CD (in 2018) ranging from 5% in sub-Saharan Africa to 43% in Latin America and the Caribbean. It is estimated that at this growth rate, by 2030, 28.5% of women worldwide will give birth by CD. Beyond medical indications, many of the CDs are performed as a result of women's and families' preferences as well as due to health professionals' views and beliefs [1]. Rates of trial of labor after cesarean (TOLAC) have uctuated over time. The main reason for the observed reduction in attempted TOLACs is the concern from uterine rupture, occurring in 0.5% of cases [2-5]. Nevertheless, the potential short-and long-term bene ts of a successful vaginal birth after cesarean (VBAC) and the relatively low incidence of uterine rupture, warrant identi cation of subgroups of women with low risk for such an event, who may substantially bene t from TOLAC. Previous studies concluded that TOLAC is a reasonable option for women with a single past CD [6-9]. It was also demonstrated that vaginal birth history, either before or after the CD, was associated with both higher rates of TOLAC success and lower rates of uterine rupture [10-14]. However, most of these studies
Uterine rupture: risk factors and pregnancy outcome
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVES: This study aimed at determining risk factors and pregnancy outcome in women with uterine rupture. STUDY DESIGN: We conducted a population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 1999. RESULTS: Uterus rupture occurred in 0.035% (n = 42) of all deliveries included in the study (n = 117,685). Independent risk factors for uterine rupture in a multivariable analysis were as follows: previous cesarean section (odds ratio [OR] = 6.0, 95% CI 3.2-11.4), malpresentation (OR = 5.4, 95% CI 2.7-10.5), and dystocia during the second stage of labor (OR = 13.7, 95% CI 6.4-29.3). Women with uterine rupture had more episodes of postpartum hemorrhage (50.0% vs 0.4%, P < .01), received more packed cell transfusions (54.8% vs 1.5%, P < .01), and required more hysterectomies (26.2% vs 0.04%, P < .01). Newborn infants delivered after uterine rupture were more frequently graded Apgar scores lower than 5 at 5 minutes and had higher rates of perinatal mortality when compared with those without rupture (10.3% vs 0.3%, P < .01; 19.0% vs 1.4%, P < .01, respectively). CONCLUSION: Uterine rupture, associated with previous cesarean section, malpresentation, and secondstage dystocia, is a major risk factor for maternal morbidity and neonatal mortality. Thus, a repeated cesarean delivery should be considered among parturients with a previous uterine scar, whose labor failed to progress. (Am J Obstet Gynecol 2003;189:1042-6.)
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: The purpose of this study was to determine the rate of uterine rupture and its complications as the result of trial of labor after previous cesarean delivery. STUDY DESIGN: PubMed was searched from 1989 to 2001, with the terms ''VBAC, uterine rupture,'' ''trial of labor, uterine rupture,'' ''cesarean delivery, uterine rupture,'' and ''scarred uterus, rupture.'' For inclusion, reports had to contain data from at least 100 patients with trials of labor that included a description of adverse outcomes. Duplicate reporting from a single institution was excluded. Odds ratios and 95% CIs were calculated. RESULTS: Seventy-two of the 361 articles (20%) that were identified met the inclusion criteria. A 6.2 per 1000 trial of labor rate of uterine rupture (total = 880 uterine ruptures in 142,075 trials of labor) was determined. For every 1000 trials of labor the uterine rupture-related complication rate was 1.8 for packed red blood cell transfusion, 1.5 for pathologic fetal acidosis (cord pH < 7.00), 0.9 for hysterectomy, 0.8 for genitourinary injury, 0.4 for perinatal death, and 0.02 for maternal death. The perinatal mortality rate was significantly lower among studies from the United States versus other countries (0.3 vs 0.6; odds ratio, 0.50; 95% CI, 0.26-0.94) and in series that exceeded 1000 patients (0.2 vs 1.7; odds ratio, 7.34; 95% CI, 3.94-13.69). CONCLUSION: Although relatively uncommon, uterine rupture is associated with several adverse outcomes, depending on the time of the publication and the site and size of the population that was studied. (Am J Obstet Gynecol 2003;189:408-17.)
Trends, risk factors and pregnancy outcome in women with uterine rupture
Archives of Gynecology and Obstetrics, 2012
Objective This study aimed at determining trends, risk factors and pregnancy outcome in women with uterine rupture. Methods A population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 2009 was conducted. Statistical analysis was performed using a multiple logistic regression analysis. Results Uterine rupture occurred in 0.06% (n = 138) of all deliveries included in the study (n = 240,189); 59% in women with a previous cesarean delivery (CD). A gradual increase in the rate of uterine rupture from 1988 (0.01%) to 2009 (0.05%) was noted. Independent risk factors for uterine rupture in a multivariable analysis were: previous CD (OR = 7.4, 95% CI 5.2-10.6), preterm delivery (<37 weeks, OR = 2.5, 95% CI 1.5-4.1), malpresentation (OR = 3.0, 95% CI 1.9-4.5), parity (OR = 1.2, 95% CI 1.1-1.3 for each birth), and dystocia during the Wrst and second stages of labor (OR = 4.1, 95% CI 2.3-7.4 and OR = 11.2, 95% CI 6.7-18.7, respectively). Uterine rupture led to signiWcant maternal morbidity and perinatal mortality. In another multivariable analysis, with perinatal mortality as the outcome variable uterine rupture was noted as an independent risk factor for perinatal mortality (adjusted OR = 17.7; 95% CI 10.0-31.4, P < .01). Conclusions Uterine rupture, associated with previous cesarean delivery, malpresentation, and labor dystocia, is an independent risk factor for perinatal mortality.
Scientific reports, 2017
Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3....